Journal of Thrombosis and Thrombolysis

, Volume 25, Issue 2, pp 179–184 | Cite as

The immediate effect of aerobic exercise on haemostatic parameters in patients with recently diagnosed mild to moderate essential hypertension

  • John Lekakis
  • Helen TriantafyllidiEmail author
  • Vasiliki Galea
  • Matina Koutroumbi
  • Theodoros Theodoridis
  • Christoforos Komporozos
  • Ignatios Ikonomidis
  • Vasiliki Christopoulou-Cokkinou
  • Dimitrios Th Kremastinos



Exercise is frequently recommended for the treatment of patients with arterial hypertension. Previous studies have shown an enhanced coagulation state after exercise. Our study investigates the alterations observed after a single session of submaximal aerobic exercise concerning coagulation, fibrinolysis, platelet activation as well as endothelial function in patients with recently diagnosed essential hypertension.


Twenty non-diabetic patients with recently diagnosed essential hypertension participated in a 45 min submaximal exercise test on a bicycle ergometer. Blood samples were drawn before and after exercise in order to determine parameters of coagulation activation (Prothrombin time [PT], activated Partial Thromboplastin time [aPTT], fibrinogen, D-Dimers, prothrombin fragments 1 + 2 [PF1+2], thrombin-antithrombin III complex [TAT] and factors VII, VIII and XII), platelet activation (Platelet count, Platelet factor 4 [PF4] and β-thromboglobulin [β-TG]), fibrinolysis activation (Plasmin-a2 antiplasmin complex, PAP) and endothelial function (soluble Thrombomodulin [sTM] and von Willebrand factor [vWf]). Soluble P-selectin served as a marker for endothelial and platelet activation.


All patients completed the exercise test. aPTT (P < 0.001) and factor VII (P = 0.01) significantly decreased while PT (P = 0.04), fibrinogen (P = 0.008), factor VIII (P < 0.001), platelet count (P = 0.002) and β-TG levels (P = 0.01) significantly increased as a result of exercise. Compared to baseline there was an 11% increase in TAT (P = 0.04) and a 28% increase in PAP (P < 0.001) at peak exercise. One hour post exercise, there was a 43% increase in PAP whereas TAT levels became similar to those at baseline. Additionally vWf (P = 0.01) and sP-selectin (P = 0.02) levels significantly increased throughout the exercise protocol.


Patients with recently diagnosed and never treated mild to moderate essential hypertension undergoing submaximal aerobic exercise present evidence of enhanced fibrinolysis compared with a mild increase of coagulation indices. However, whether there is a favourable effect of exercise on fibrinolysis over coagulation and/or endothelial involvement during exercise needs to be further investigated.


Aerobic exercise Essential hypertension Haemostatic disorders Endothelial function 


  1. 1.
    El-Sayed MS, El-Sayed ZE, Ahmadizad S (2004) Exercise and training effects on blood haemostasis in health and disease. An update. Sports Med 34(3):181–200PubMedCrossRefGoogle Scholar
  2. 2.
    Smith JE (2003) Effects of strenuous exercise on haemostasis. Br J Sports Med 37:433–435PubMedCrossRefGoogle Scholar
  3. 3.
    Womack CJ, Rasmussen JM, Vickers DG, Paton CM, Osmond PJ, Davis GL (2006) Changes in fibrinolysis following exercise above and below lactate threshold. Thromb Res 118(2):263–268PubMedCrossRefGoogle Scholar
  4. 4.
    Ahmadizad S, El-Sayed MS, Maclaren DP (2006) Responses of platelet activation and function to a single bout of resistance exercise and recovery. Clin Hemorheology Microcirculation 35(1–2):159–168Google Scholar
  5. 5.
    El-Sayed MS, Al N, El-Sayed Ali Z (2005) Aggregation and activation of blood platelets in exercise and training. Sports Med 35(1):11–12PubMedCrossRefGoogle Scholar
  6. 6.
    Lee KW, Lip GY (2003) Effects of lifestyle on haemostasis, fibrinolysis, and platelet reactivity: a systematic review. Arch Intern Med 163(19):2368–2392PubMedCrossRefGoogle Scholar
  7. 7.
    Hedge SS, Goldfarb AH, Hedge S (2001) Clotting and fibrinolytic activity change during the 1 h after a submaximal run. Med Sci Sports Exerc 33:887–892CrossRefGoogle Scholar
  8. 8.
    Lin X, El Sayed MS, Waterhouse J, Reilly T (1999) Activation and disturbances of blood homeostasis following strenuous physical exercise. Int J Sports Med 20:149–153PubMedCrossRefGoogle Scholar
  9. 9.
    Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE (1993) Triggering of acute myocardial infarction by heavy physical exertion. N Engl J Med 329:1677–1683PubMedCrossRefGoogle Scholar
  10. 10.
    Tofler GH, Stone PH, Maclure M, Edelman E, Davis VG, Robertson T, Antman EM, Muller JE (1990) Analysis of possible triggers of acute myocardial infarction (the MILIS study). Am J Cardiol 66:22–27PubMedCrossRefGoogle Scholar
  11. 11.
    Willich SN, Lewis M, Lowel H, Arntz HR, Schubert F, Schroder R (1993) Physical exertion as a trigger of acute myocardial infarction. N Engl J Med 329:1684–1690PubMedCrossRefGoogle Scholar
  12. 12.
    van den Burg PJM, Hospers JEH, van Vliet M, Mosterd WL, Bouma BN (1995) Changes in haemostatic factors and activation products after exercise in healthy subjects with different ages. Thromb Haemost 74(6):1457–1464PubMedGoogle Scholar
  13. 13.
    Andreotti F, Lanza GA, Sciahbasi A Fischetti D, Sestito A, De Cristofaro R, Maseri A (2001) Low grade exercise enhances platelet aggregability in patients with obstructive coronary disease independently of myocardial ischemia. Am J Cardiol 87(1):16–20PubMedCrossRefGoogle Scholar
  14. 14.
    Li-Saw-Hee FL, Blann AD, Edmunds E, Gibbs CR, Lip GY (2001) Effect of acute exercise on the raised plasma fibrinogen, soluble P-selectin and von Willebrand factor levels in chronic atrial fibrillation. Clin Cardiol 24:409–414PubMedCrossRefGoogle Scholar
  15. 15.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252PubMedCrossRefGoogle Scholar
  16. 16.
    Kaplan KL, Owen J (1981) Plasma levels of β- thromboglobulin and platelet factor 4 as indices of platelet activation in vivo. Blood 57(2):199–202PubMedGoogle Scholar
  17. 17.
    Cadroy Y, Pillard F, Sakariassen KS, Thalamas C (2002) Strenuous but not moderate exercise increases the thrombotic tendency in healthy sedentary male volunteers. J Appl Physiol 93(3):829–833PubMedGoogle Scholar
  18. 18.
    Mustonen P, Lepantalo M, Lassila R (1998) Physical exertion induces thrombin formation and fibrin degradation in patients with peripheral atherosclerosis. Arterioscler Thromb Vasc Biol 18:244–249PubMedGoogle Scholar
  19. 19.
    Rankinen T, Vaisanen S, Pentilla I, Rauramaa R (1995) Acute dynamic exercise increases fibrinolytic activity. Thromb Haemost 73:281–286PubMedGoogle Scholar
  20. 20.
    Desouza CA, Dengel DR, Rogers MA, Cox K, Macko RF (1997) Fibrinolytic responses to acute physical activity in older hypertensive men. J Appl Physiol 82:1765–1770PubMedGoogle Scholar
  21. 21.
    Juhan-Vague I, Alessi MC (1993) Plasminogen activator inhibitor 1 and atherothrombosis. Thromb Haemost 70:138–143PubMedGoogle Scholar
  22. 22.
    El Sayed M (2002) Effect of alcohol ingestion post-exercise on platelet aggregation. Thromb Res 105:1–5CrossRefGoogle Scholar
  23. 23.
    Bourey RE, Santoro SA (1988) Interaction of exercise, coagulation, platelets and fibrinolysis: a brief review. Med Sci Sports Exerc 20:439–446PubMedGoogle Scholar
  24. 24.
    Ahmadizad S, El-Sayed M (2003) The effect of graded resistance exercise on platelet aggregation and activation. Med Sci Sports Exerc 35:1026–1032PubMedCrossRefGoogle Scholar
  25. 25.
    Hurlen M, Seljeflot I, Amesen H (2000) Increased platelet aggregability during exercise in patients with myocardial infarction: lack of inhibition by aspirin. Thromb Res 99:487–494PubMedCrossRefGoogle Scholar
  26. 26.
    El-Sayed MS (1996) Effects of exercise on blood coagulation, fibrinolysis and platelet aggregation. Sports Med 22:282–298PubMedCrossRefGoogle Scholar
  27. 27.
    Lekakis J, Papathanassiou S, Papaioannou TG, Papamichael CM, Zakopoulos N, Kotsis V, Dagre AG, Stamatelopoulos K, Protogerou A, Stamatelopoulos SF (2002) Oral L-arginine improves endothelial dysfunction in patients with essential hypertension. Intern J Cardiol 86:317–323CrossRefGoogle Scholar
  28. 28.
    Rondaij MG, Bierings R, Kraqt A, van Mourik JA, Voorberg J (2006) Dynamics and plasticity of Weibel-Palade bodies in endothelial cells. Arterioscler Thomb Vasc Biol 26(5):1002–1007CrossRefGoogle Scholar
  29. 29.
    Felmeden DC, Spencer CGC, Chung NAY, Belgore FM, Blann AD, Beevers G, Lip GYH (2003) Relation of thrombogenesis in systemic hypertension to angiogenesis and endothelial damage/dysfunction (a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial [ASCOT]). Am J Cardiol 92:400–405PubMedCrossRefGoogle Scholar
  30. 30.
    Wun T, Paglieroni T, Lachant NA (1996) Physiologic concentrations of arginine vasopressin activate human platelets in vitro. Br J Haematol 92:968–972PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • John Lekakis
    • 1
  • Helen Triantafyllidi
    • 1
    Email author
  • Vasiliki Galea
    • 2
  • Matina Koutroumbi
    • 1
  • Theodoros Theodoridis
    • 2
  • Christoforos Komporozos
    • 1
  • Ignatios Ikonomidis
    • 1
  • Vasiliki Christopoulou-Cokkinou
    • 2
  • Dimitrios Th Kremastinos
    • 1
  1. 1.2nd Cardiology Department, Attikon Hospital, Medical SchoolUniversity of AthensAthensGreece
  2. 2.Haematology LaboratoryEvangelismos HospitalAthensGreece

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